Experimental Epididymitis Induced by Repeated Injection of Homologous and Heterologous Epididymal Tissue with Adjuvant / 대한비뇨기과학회지

A number of chronic inflammatory lesions of unknown etiology in man have recentlybeen understood by the mechanism of so called auto-immune disease and a series of experimental study using animals have been extensively undertaken to reproduce the lesion. Experimental chronic inflammatory diseases induced by repeated injection of homologous or heterologous tissue antigen with adjuvant are based upon immunological process and these are readily reproducible. The author has experimentally studied on any allergic destruction of the epididymis of the rat on immunologic process as in other particular organs and tissue. A total of 59 white healthy male rats were divided into 7 major experimental groups of injection as follows. Group 1: six rats, control, injection with normal saline alone. Group 2: six rats, injection with adjuvant only. Group 3: six rats. injection with epididymal tissue only. Group 4: twenty-three rate, injection with rat epididymal tissue plus adjuvant. A. seven rats, sacrificed on the 64th day B. ten rate, sacrificed on the 92nd day C. six rats, sacrificed on the 128thday Group 5. six rate, injection with rat epididymal tissue plus adjuvant plus prednisolone. Group 6: six rats, injection with rabbit epididymal tissue only Group 7: six rats, injection with rabbit epididymal tissue plus adjuvant Injections were given into the abdominal muscle of the rat once s week for 8 weeks as scheduled in the text and the animals of all groups except the group 4, were sacrificed 8 days after the final injection. In the group 4, animals were further divided into 3 subgroups which were sacrificed on the 61st, 92nd and l28th day of the experiment, respectively. The epididymis and other organs of allexperimental animals were studied histopathologically and the following results were obtained; 1. In all rats of the group 1 receiving homologous epididymal tissue with adjuvant, the epididymis revealed relatively marked and significant inflammatory changes. Histopathology included edema, congestion, fibrosis in the interstitial tissue, and infiltration of inflammatory cells mainly composed of lymphocytes, histiocytes, plasma cells and eosinophils. Flattening and hyperplasia of the epithelial cells and cellular exsudation were observed in the tubules. 2. In the group 1, the lapse of time after injection provoked more marked inflammatory changes. Diffusely mild or moderate degree of inflammation observed on 61st day, was changed to diffusely moderate or marked inflammation on 92nd day and then to significantly more chronic lesion with less exsudation and more fibrosis on 128th day. 3. Homologous tissue antigen without adjuvant andheterologous tissue antigen with or without adjuvant caused no inflammatory changes. 4. Inflammatory changes induced by homologous tissue antigen with adjuvant seem to be readily inhibited or prevented by simultaneous administration of prednisolone.

Clinical Experiences with Cases of Intersex / 대한비뇨기과학회지

In recent years active research on sexual anomalies, especially on the conditionsof intersex is rapidly progressing. It is not until Barr et al, have clarifiedthe epochmaking discovery of sex chromosome test that the concept of chromosomalintersex was firmly established. Reported here are 6 cases of intersex admittedto the Department of Urology, Seoul National University Hospital. Aceerding tothe results of observation on the sex chromatin. external or internal genitalia,in some, hormonal balance, utilizing various methods of urological examination, 6 cases of intersex have been confirmed. These patients consist of 1 case of truehermaphroditism, 2 cases of male pseudohermaphroditism. 2 cases of femalepseudohermaphroditism with congenital adrenogenital syndrome and one case ofKinefelter's syndrome. In summary the first case of true hermspbroditismapparently looked like a hypospadiac male with atrophied testis as gonad but afterpuberty the ovarian activity became manifest and gynecomastia developed. Therefore is out of the question that this case is a true hermaprodite possessing bothtestis and ovary. Considering this patient's sex of rearing, correction of hypospadia was performed. This patient leads his social life by virtue oftestosterone supply. The second case is a male pseudohermaphroditism patientconfirmed by exploratory laparotomy which revealed degenerative change of femalegonads and reproductive organ. However, the active gonad was testis andaccordingly it is apparent that this is a male pseudohermaphroditism case. Thispatient had the hope to live as a female. Therefore according to the patient's own wish, hypospadia correction plus phallectomy and vaginoplasty were performedand was feminized. Estrogen therapy has been received, but masculinizing symptomsare still present. The 3rd case had severe hypospadia with cryptorchism. Theexternal appearance, however, was like that of a female. Laparotomy revealed no gonads or reproductive organ. Biopsy revealed atrophic testis. Therefore thediagnosis of sale pseudohermaphroditism was made. This child was performedhypospadia correction and was decided to be reared as a male. The 4th case afirmly established adrenogenital syndrome patient, has received clitoridectomyand cortisone therapy was indicated and is under observation. The 5th case alsois a child with adrenogenital syndrome. Bilateral partial adrenalectomy wasperformed and simultaneously cortisone therapy was continued. However, clinical manifestations of Cushing's syndrome appeared because of overdosage of cortisone. In this case, clitoridectomy and vaginoplasty were performed. The 6th patient was a chromosomal intersex. Chromosomal test was positive and large gynecomastia was present. Testicular biopsies revealed characteristic findings of the Klinefelter's syndrome. There were hyalinzed seminiferous tubules, hypertrophy of the basement membrane, and an increased number of interstitial cells appearing in clumps. Testosterone therapy was performed to correct mental symptoms and decreased libido. Gynecomastia is to be removed surgically. It is important on the diagnosis of intersex to confirm the existence of urogenital sinus. Urogenital sinus was present in 4 of our cases. As with 2nd case, adaptability of patients with intersex will be more secure to make the social sex as a female than to make it as a male. Recent related literatures were reviewed.

A Prominently Large Glans penis as a Possible sign of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Eighteen unselected, consecutive cases of benign prostatic hyperplasia, 18 unselected cases of other urological conditions in same age group have been studied with particular reference to the size of the glans penis. Of 18 cases of benign prostatic hyperplasia,17 had prominently well-developed and large glans penis-"prostate-glans"-, while all cases of carcinoma of the prostate and most of control cases had small or ordinary-sized glans. There was no close correlation between the size of the glans and grade of prostatic enlargement. From this study, it might be concluded that prominently large glans is a possible sign of benign prostatic hyperplasia and those who have very large glans in association with urinary obstruction in elderly males are likely to have benign prostatic hyperplasia.

Experimental Prostatitis Following Repeated Injection of Homologous and Heterologous Prostatic Tissue / 대한비뇨기과학회지

The mechanism of so-called auto-immune disease has been studied extensively andthe growth of a unitary theory to explain the causation of many human diseasesnow bids fair to compass virtually all ailments. This view is based on closerelation between experimental auto-allergic destruction of a particular organ andthe spontaneous human diseases affecting the organ. Evidence in the form ofcirculating antibodies reacting specifically in vitro with extracts ofappropriate organs has accumulated on a broad scale. Experimental allergicdiseases induced by repeated injection of homologous or heterologous organ andtissue antigen in company with adjuvant, based on immunological process, havebeen reported. More recently, a possible role of immunological process inmechanism of prostatitis in association with Reiter's disease has been broughtforth. This study was undertaken to know any allergic destruction of the prostateon immunologic basis as in other particular organs and tissues. In this study atotal of 45 healthy adult white rats of 7 groups were used and injection of thefollowing were given intramuscularly once a week for 6 weeks.Group 1. six rats, control, normal saline alone.Group 2. six rats, adjuvant alone.Group 3. six rats, rats prostate alone.Group 4. nine rats, rat prostate tissue with adjuvant.Group 5. six rats, rat prostate tissue with adjuvant and prednisolone.Group 6. six rats, rabbit prostate tissue alone.Group 7. six rate, rabbit prostate tissue with adjuvant.The prostate of all experimental animals were studied hislopathologically and the following results were obtained: 1. In 8 of 9 rats of the group 4 receiving homologous prostatic tissue with adjuvant, the prostate showed marked and significant inflammatory changes including diffuse or local interstitial infiltration of lymphocytes, histiocytes and eosinophiles. These changes are more marked in the ventral lobe than in the dorsal lobe. 2. These changes are so-called organ and species specific reaction based on immunological process which is initiated by stimulation of tissue antigen. 3. These allergic reaction is readily inhibited or prevented by administration of prednisolone.

Statistical Observation on Tumors of the Genito-urinary Tracts (1954-1965) / 대한비뇨기과학회지

A statistical observation was made on tumors of the genito-urinary tracts of the in-patients in the Department of Urology, Seoul National University Hospital during the period April, 1954 through August, 1965 and the following results were obtained. 1. During the period, of 1,346 cases (1,026 males and 3211 females) hospitalized, 180 cases (157 males and 23 females) had tumors of the genito-urinary tracts, giving a rate of 13.43% (male: 11. 66%, female: 1.77%). 2. A gradual tendency of annual increase of the tumors is observed. 3. Of 180 cases, 153 cases or 85.0% were seen by us at the ages of 40 or more, and 27 cases or 15.0% at the ages of 39 years or below. 4. Of the tumors, 85 cases or 17.22% were vesical, 59 cases or 33. 78% prostatic, 15 cases or 8.33 % penile, 13 cases or 7.2% renal, 3 cases or 1.67% testicular and 1 case or 0.56% epididymal, the lowest. 5. Transitional cell carcinoma of bladder is observed in 31.1% of all tumors, B. P. H. in 21.6%, squamous cell carcinoma of penis in 8.3%, adenocarcinoma of prostate in 7.7% and renal cell carcinoma in 3.7%.

STUDIES ON VASECTOMY: III. Clinical Studies on the influence of vasectomy / 대한비뇨기과학회지

About 60,000 men were undergone voluntary sterilization by the 497 designated doctors during the period from 1962 to October 1965 by the government subsidy program. Besides these numbers more than 15,000 private cases were sterilized by private doctors during the period from 1960 to 1964 in Korea. A general comprehension of the sterilization operation for motivation of customers was illustrated. An analysis of the social history and background of the sterilized men were made on the author's private group and the subsidized group. The most common occupation of the private group was commerce and that of the subsidized group was africulture. The duration intervening between marriage and sterilization indicated 13.6 years in the private group and 16.7 years in the subsidized group. An average age of the sterilized men showed 40 and that of their wives 35. An average number of children of the private group showed 4.7 while that of subsidized group indicated 5.3. Sexual drive following the sterilization was not changed in 81 per cent of the private group and in 71 per cent of the subsidized group. Decrease in sexual activity was revealed in 5 per cent of the private group but in 11 per cent of the subsidized group. General health after the sterilization was not changed in 83 per cent of the private group and in 70 per cent of the subsidized group. Decrease in general health was noted in only 6 per cent of the private group but in 11 per cent of the subsidized group. Frequency of sexual intercourse per week of the private group indicated 1.95 times preoperatively and 1.88 times postoperatively whereas that of the subsidized group revealed 2.27 times preoperatively but 1.99 times postoperatively. In regarding the sexual feeling of their wives, more than 87 per cent of the private group showed no change before and after the operation while 71 per cent of the wives of the subsidized group were not changed. Very few wives of the private group complained of some decrease, but 10 per cent of the subsidized group complained decrease. The time lost from work after the sterilization was about 2 days in the private group while about 8 days in the subsidized group. About 93 per cent of the private group were satisfied with the sterilization but 2 per cent of them did not feel happy after the operation. In the subsidized group 88 per cent were satisfied with the operation but 10 per cent were not satisfied. All of the private group and 80 per cent of the subsidized group would recommend the sterilization method to their friends. Untoward effects on sexual drive and general health are found to be higher in the subsidized group than in the private group. These outcomes are partly due to low edcation and low income of the subsidized group compared with the private group and partly due to unsatisfactory operative technique of the designated doctors. Psychological studies by means of MMPI conducted on 20 sterilization neurosis patients and the results were compared with the control nonvasectomized group. The sterilized group had definite psychological instability so that a preoperative psychological interview is found to invariably be necessary to prevent the sterilization neurosis. It is concluded by this preliminary clinical survey of the vasectomized cases through the author's private system and the government subsidy program that the few who told to decrease in sexual capacity and general health were outnumbered by those reporting an increase. The majority of the cases told of no change. The changes noted by a small proportion of patients appeared to be chiefly of psychological origin because there was no physiologic reason why the operation of vasectomy should causes sexual excess or decrease.

Studies On Vasectomy: II. Anastomosis of the vas Deferens / 대한비뇨기과학회지

An anastomosis of the vas deferens was performed on 17 patients since 1963.Semen specimens were examined repeatedly in 15 cases of the series after periods from 2 to 24 weeks following removal of the splint. The fifteen were found to have viable sperm in their ejaculates but one of these patients subsequently became azoospermic again. Three of the fifteen cases had some degree of deteriorated effects after the previous vasectomy but they were free of the complications following the successful anastomosis of the vas deferens. Operative rechnics were discussed. In this series 2-0 dermalon was used as a splint in 15 cases and stainless steel wire was used in 2 cases. Liothyronine was given to 16 of 17 patients at or before the operation for periods from 1 to 6months. Over-all successful results would indicate about 65 per cent of the cases operated in the literature. The author's small series indicates that more than 90 per cent of the operated cases could be successful in this operative procedure from the cytological point of view.

Studies on Tuberculosis of the Epididymis: 1. Clinical observation on tuberculosis of the Epididmis / 대한비뇨기과학회지

Two-hundred and fourteen cases of tuberculosis of the epididymis seen during the period from April 1957 to March 1965 were studied clinically and the following results were obtained: (1) Incidence of tuberculosis of the epididymis is 1.4% of all urological diseases or 22.4% of tuberculosis of the urinary tract of the male. (2) The highest occurrence is observed in the ages of 20 to 39(75.7%) and the lowest in the ages below 9 and above 60 (0.9%) respectively. (3) Lateralization shows 31.8% in the right, 24.3 % in the left and 43.9 % in the both. The site of invasion is most popular in the tail (47.8 %) and the size up to thumb size was observed in 89.4 %. (4) Discovery of tuberculous invasion in the remainder following unilateral epididymal lesion is made within 2 years 7 months. Transfer of tuberculosis of the other organ to the epididymis requires 6 years 3 months. (5) In 42.9 %, tuberculous diseases were present in the past history ; The pleura, the lung and the urinary tract were most frequently invaded. (40.6 %) (6) Approximately half of the cases requested medical care within one month after discovery of the lesion. (7) Of presenting symptoms, swelling of the epididymis was observed in 73.8 %, frequency of urination 27.1 % and hematuria in 20.1 %. (8) Three or more c.c. of ejaculate were observed in 24.1 %, counting of sperm disclosed azoospermia in 41.4 % oligospermia in 35.5 % and normospermia in 20.7 %. (9) In urine examination, W. B. C. 5/H. P. F. or more is observed in 70.7 %, RBC 3/H. P. F. or more in 40.5 %, albumin in 61 % and tubercle bacilli in 27.4 %. (10) In prostatic smear, WBC 10/H.P.F. or more is observed in 69.7 %, RBC 5/H.P.F. or more in 18.3 % and tubercle bacilli in 7.7 %. (11) Proatatic tuberculosis is the commonest complication of epididymal tuberculosis (67,8 %). (12) Local injection with 0.3-0.5 cc of 30 % streptomycid solution directly in the lesion appeared to be very effective in 11 of 13 cases. This treatment is to be used prior to surgery.

Studies on Tuberculosis of the Epididymis: 2. Influence of Chemotherapy on tuberculous lesions of the Epididymis / 대한비뇨기과학회지

Forty five cases of tuberculosis of the epididymis were classified according to grade of invasion and length of antituberculous chemotherapy and the histopathological response to chemotherapy was evaluated as follows: 1) Tuberculosis of the epididymis is graded according to the size and extent of invasion. Grade I (mild) A single nodule in size of small finger tip or smaller in the head, body or tail is palpable. Differentiation with nonspecific lesion is very difficult. Grade II (moderate): A single nodule in size of index finger tip or smaller ie palpable. No adhesion is noticeable. Grade III (advanced): One or two nodules in size of thumb or smaller are palpable. Adhesion is present or absent and the vas shows thickening. Grade IV (far advanced): Tow or more nodules in size of thumb or larger are palpable and scrotal fistula or abscess present. Adhesion is usually present and the beaded vas is palpable. 2) Histopathological response to chemotherapy are as follows: a) Caseation: the longer the duration of chemotherapy the less the caseation is present. b) Epitheloid cells show degeneration, atrophy and decrease. c) Giant cells show degeneration, atrophy, vacuolization and decrease. d) Perifocal reaction is reduced gradually upon chemotherapy. e) Fibrosis is very significant in the group of treatment and vacuolization readily occurred early in the chemotherapy with longer chemotherapy. Hyalinization of fibrous tissue is prominent f) Lymphocytic infiltration and vacuolization are observed both in treated and untreated groups, more significant in the first. g) Almost same grade of reticulosis is observed both in the treated and untreated groups. h) It was observable that among the testis, epididymis and the vas deferens, somewhat faster response to the chemotherapy vas obtained in the vas than in the epididymis and the testis showed the slowest response to the chemotherapy. i) Significant histopathological response is obtained in the group of two months or longer chemotherapy, j) From these observations, the author is of belief that extensive chemotherapy is only indicated for epididymal tuberculosis of grades I and II without surgery. However, the grades III and IV lesions require surgical intervention following a trial with chemotherapy for 2 months or longer.

Statistical Observation on Patients In the Department of Urology In 1964 / 대한비뇨기과학회지

Statistical survey was made on out-patients and in-patients in the Department of Urology, Seoul National University Hospital during the period from January to December in 1964. Of 2,873 out-patients including 2,346 males and 527 females, 234 cases (171 males and 63 females) were hospitalized and various operations were performed on 195 occasions. The following tables are self-explanatory.

Effect of 5-fluorouracil on carcinoma of the bladder / 대한비뇨기과학회지

5-Fluorouracil was used for the treated of 4 cases of carcinoma of the bladder along with electrocoagulation, X-ray radiation, Cobalt teletherapy and estrogen and its effectiveness was evaluated Further experience with this druy is necessary for detailed evaluation, though the cases reported herein seems to have responded to this chemotherapy to some extent.

Evaluation of the Chemotherapy on Tuberculous Lesions of the Kidney / 대한비뇨기과학회지

In spite of the great measure of recent success in tuberculosis withchemotherapy, it is still one of the most fundamental questions in what state ofrenal tuberculosis should be treated surgically. So as to set up a criterion onthe chemotherapy, forty-nine extirpated tuberculous kidneys were observed withmy own classification of tuberculous renal lesions. 1. The lesions were classified macroscopically and pyelographically according to the development of renal tuberculosis (1) Those with neither change of calyceo-pelvic system nor pyelographical abnormality were named Class O. representing parenchymal tubercles. (2) Those with only infiltration in the tip of papilla were named Class I, showing caliectasis or clubbing pyelographically. (3) Those with initial minor ulceration in calyceal system were named Class II, showing fuzzy irregular or moth-eaten outline pyelographically (4) Those with progressed distorted ulceration were named Class III, showing definite irregular deformity but still keeping some semblance to the original calyceal form pyelographically. (5) Those with cavitation, open or closed were named Class IV, showing irregularly outlined shadow without original anatomic form pyelographically. (6) Those with tuberculous pyonephrotic ectasis were named Class E, showing less irregularly out lined cavity shadow pyelographically. 2. Tuberculous kidneys might also be graded clinically and pyelographically with the classification of the lesions. (1) The tuberculous kidneys with early lesions,i.e. Class O, Class I and/or Class II were called minimal renal tuberculosis.(2)Those with intermediate lesions. i.e. Class III were called moderate. (3) Those with a progressed lesion, i.e. Class IV or Class E were called advanced. (4) Those with two or more lesions of Class IV and/or Class E were called far advanced. 3. The lesions belong to each Class were divided again into untreated control group and three treated groups with triple drug therapy of different durations and the macroscopical and histopathological appearances in each treated group were compared with in untreated one. 4. Macroscopically the lesions in treated kidney with remaining excretory function and without obstruction showed tendency toward clearing of caseous material in each class.5. The specific reactions in tuberculous tissue were improved histopathologically in proportion to duration of the therapy. (1) Caseous material was cleared up. (2) Epithelioid cells revealed sufficient degeneration and diminution, occasionally complete disappearing. (3) Giant cells also revealed degeneration, vacuolation and diminution, frequently complete disappearing. 6. The severity of non-specific tissue reactions in the lesions. i.e. connectivetissue reaction, parenchymal degeneration and defect, interstitial inflammation and lymphocytic infiltration was not influenced by duration of the therapy, but depended on Class of lesions at the time of therapy began. 7. The repairing reactions in the lesions were increased according as prolongation of the therapy, but there might be some variety between the different reactions. (1) Vascularization: according as the duration, but not remarkable. (2) Regeneration of epithelium: according as the duration, but only partial covering. (3) Vacuolation: significant, however, also noticed in untreated group. (4) Reducing of perifocal reaction: according as the duration, but not sufficient in the progressed lesions.8. In the more progressed tuberculous lesions, specific and non-specific tissuereactions predominsted over repairing, therefore histological healing was more delayed. 9. There were noticeable evidences of histological improving in the specimens from patients with triple drug therapy for more than three months. 10. As a result of these observations, I should like to recommend that: (1) for minimal renal tuberculosis, chemotherapy is continued; (2) for moderate, chemotherapy is tried firstly, and if the lesions are persistent or worsened surgery will be considered; (3) for advanced and far advanced, surgery including partial nephrectomy is preferable after at least three month chemotherapy.

Studies on Vasectomy: II. Comparative Studies of Splinting Materials on the Vas Anastomosis of the Animals and a Report of Consecutive Successful Anastomosis of the Humans / 대한비뇨기과학회지

A total of 42 vas anastomoses was performed on experimental animals and successful anastomoses were obtained 19 of the cases and the over-all rate of success was approximately 46 per cent. But 13 dogs in total of 21 dogs were found to be patent in at least one side of vas, or about 65 per cent of total dogs were restored their fecundity. Splinting materials used in this comparative study are chromic catgut, stainless steel wire, dermalon and polyethylen tube, and dermalon has been proved as the most excellent splinting material among thembecause it is no figid but plable and makes no tissue reaction in the vas. Successful anastomosis of vas deferent is affected by many factors. Among these, an inadequate splinting material has been considered as the most important causes of failures. But it should seem that minimal dissection of the tied points of vas as satisfactory approximation of the free ends of vas exert very important effect upon the successful anastomosis as the splinting material does. Consecutive four successful anastomosis of human cases are highly satisfactory results and are very encouraging even in a small series of cases of the present study.

A Clinical Study of the Organ Distribution and Renoscintigram with Hg203 Labeled Neohydrin in Renal Diseases / 대한비뇨기과학회지

The delineation of the functioning renal parenchyma by the scintiscanning technique has made it possible to supplement diagnostic informations obtained by ordinary urological laboratory data, intravenous pyelography, retrograde pyelography or aortic angiography. More recently, the Hean labeled neohydrin has turned out to be preferable to I131 labeled diodrast or hippuran for renoscintigram for that the former is more readily taken up by the renal cortex and retained by the renal tubules for certain period of time, while the latter istoo rapidly excreted in the urine to reveal satisfactory pictures of renoscan and the technique is complicated. In the present study, renal scintillation scanning and body surface counting in vivo by Hg203 neohydrin were performed on 10 normal cases and 50 patients, 2 renal tumor (Wilm's tumor), 12 renal tuberculosis, 6 renal calculi, 5 nephritis, 10 hydronephrosis. 1 nephrotic syndrome. 5 pyelonephritis, 1 polycystic kidney, 3 congenital anomalies (horse-shoe kidney) and 5 hypertension. After intravenous administration of about 100 microcuries of Hg203 labeled neohydrin, in vivo surface counting over the kidneys, liver, spleen, heart and thigh was performed prior to scan such kidneys at 5, 30, 60 and 90 minutes, respectively, by scintillation detector with 1.5 inches thick Na I crystal. Upon adequate concentration of Hg203 neohydrin in the kidneys, the outline of functioning renal parenchyma can then be recorded by scintillation scanning apparatus, 19 honey cone collimator. In body surface counting, the radioisotope concentration over normally functioning renal parenchyma is good, whereas the concentration over diseased parenchyma is poor and the hepatic uptakeof the isotope shows high, instead. This procedure would also be of diagnostic value in patients with renal vascular disease, by revealing renal function test. In renoscintigram of the patients having presumable renal diseases by ordinary urological survey and pyelographic techniques, space occupying lesions and dot irregularities of the kidney can be presented as filling defect on renoscan. Split renal function studies usually give some information about total functioning capacity of each kidney but no detailed information in limited areasof a kidney with segmental lesion can be drawn. The renal angiogram details in a precise way the size and course of the renal arteries, but contributes no information about function of the parenchyma. The renal biopsy is also a valuable diagnostic procedure which may provide a specific diagnosis if the biopsy is obtained from the right site of diseased area. And the radioisotope renogram has been used to detect unilateral renal disease and it provides some information about the vascular supply and functional capacity of each kidney but this procedure does not supply any knowledge on segmental renal lesion nor segmental renal function. The technique of renoscintigram using Hg203 neohydrin which supplements the disadvantages of conventional methods of renal function study is at the present most qualified to supply more knowledge on segmental renal function and morphological finding as well. Further-more, disappearance of the isotope from the blood and its urinary excretion rate were determined as no harm at all to the human body. In summary, the renoscintigram is of particular help in establishing the diagnosis of renal diseases where pyelographic evidence is equivocal or lacking and the diagnostic significance of this method is promising.

Pyelographic Observation on Renal Tuberculosis / 대한비뇨기과학회지

Pyelographic examination is very essential in diagnosis of renal tuberculosis along with detection of tubercle bacilli in the urine and cystoscopic procedure. Furthermore, it is that the pyelography gives the very important and influencing information on therapeutic indication, surgical intervention how to and when to operate, and on forecasting prognosis. It therefore, is requested that grade of tuberculous invasion, its correct localization and its itemized classification be established most carefully. In the present study, 120 pyelograms made out of 197 cases of renal tuberculosis at the Department of Urology. Seoul National University Hospital, during the period January 1957 through June 1963, were collected and detailed pyelographic interpretation on plain films, intravenous pyelograms (I.V.P.) of individual tuberculous kidneys (from 120 patients) and on 50 retrograde pyelograms was attempted and the following results were obtained: Thereafter, an individual kidney will be counted as one case. 1) Of 152 cases of plain film, calcification in the kidney area was found in 6 cases or 3.9%, and renal calculus in 4 cases or 2.6%, kidney outline was observed in 24.3%. Plain film should be all made prior to perform pyelography. 2) Functional classification of intravenous pyelogram was made into 5 groups according to grade of visualization of contrast media as the following Group 1: Pelvio-calyceal system is well visualized, revealing the neighborhood of uretero-pelvic juncture precisely. Group 2: Most calyces are essentially visualized but no pelvis is outlined. The entire picture can not be drawn. Group 3: Only one to two calyces or cavities are filled with contrast media. They appear at most times round, oval or hazy figures. This group may stand for advanced group 2. Group 4: Contrast media seem to be visualized in traces but no outline of calyx nor pelvis observable. Group 5: Absence of visualization. 3) Most commonly observable urographic changes in intravenous pyelogram can be listed as: (1) absence of visualization, 43.1% ;(2) delayed visualization, 37%; (3) caliectasis, 36% ; (4) feathery, irregular or "moth-eaten" outline of calyces, 33.5%; (5) deformity, narrowing or dilation of the ureter, 26%; (6) obliteration of one or more calyces, 8.6% ; (7) cicatrical deformity of the calyces and "pinching off" of the tips of minor calyces, 7.2% ; (8) poor visualization with only one or two "globs" of contrast medium, 5.9% and (9) pyelectasis, 2.6%. 4) After injecting contrast media in intraveuous pyelography, the more the kidney involved, the lower the appearance and the intensity of nephrogram observed. 5) Retrograde pyelograms were classified into four grades after Lattimer and they were studied along with appearance of contrast media in intravenous pyelogram. The more invasion by retrograde pyelogram indicated, the later the appearance of contrast media and the poorer visualization observed. 6) Retrograde anatomical grading and intravenous functional classification were compared and it was almost likely that they paralleled pretty well. Nintythree per cent of I.V.P. below group 2. inclusive, showed more marked anatomical involvement than grade III of retrograde pyelogram.

A Statistical Study on Urolithiasis II / 대한비뇨기과학회지

A statistical analysis was made on 468 cases of urolithiasis during the period April 1951 to September 1962, and the following data were obtained: 1. The incidence of the patients with the stones was 2.25 percent of total urological outpatients and 25.4 percent of the ward patients. 2. Incidences of urinary calculi are increasing year by year; 3.6 per cent in 1954, 12.8 per cent in 1958, and 20.7 per cent in 1962. 3. The incidence of stones in the upper urinary tract seemed to increase significantly while that of the lower tract did not. The ratio of upper urinary tract calculi over ones in the lower tract (24 : 76 in 1954), reversed with greatly increasing incidence of upper urinary tract calculi (69: 31 in 1962). 4. These stones consisted of renal stone in 14.5 per cent, ureteral stone in 45.6 per cent, bladder stone in 25.6 per cent and urethral stone in 13 per cent. 5. The stones were most commonly found between the ages of 20 to 50. The upper urinary tract calculi were more frequently seen in young adults but in aged and children lower urinary tract calculi were common. 6. The stones were found to occur predominantly in males than in females and the ratio was 5.4 : 1. 7. The upper urinary tract calculi occurred both in the left and right sides with approximately equal frequency. It was estimated that bilateral urinary calculi occurred in 6 per cent of the cases. 8. Multilocations of the stones in the urinary tracts occurred in 7 per cent of the total stones. 9. Seventy-three per cent of the ureteral stones were lodged in the lower ureter. 10. The results of qualitative chemical examination of stones were calcium oxalate in 30.7 per cent, calcium phosphate in 28.5 per cent, apatite in 19.3 per cent, uric acid and calcium phosphate in 9.1 per cent, uric acid and calcium oxalate in 6.8 per cent, uric acid in 3.4 per cent, and carbonate in 2.2 per cent. 11. Three hundred and nine of 468 cases were treated in the clinic. Spontaneous passage occurred in 10.4 per cent, 41.6 per cent were expelled following instrumental manipulation and 18.6 per cent were subjected to surgical intervention.

Endoscopic Examination on One-Hundred Cases of Female Urethritis / 대한비뇨기과학회지

One-hundred cases of female urethritis unselected were studied endoscopically. The urethra, the bladder neck and the bladder were endoscoped carefully and they were classified into four groups as follows: Group 1: Almost normal urethra and bladder neck or with very mild mucosal changes, 8 case. Group 2: Narrowing of the urethral lumen without marked mucosal changes, 8 cases. Group 3: Diffuse bullous edema of the urethra and bladder neck, 44 cases. Group 4: Bullous edema with pseudopolyps or irregular urethral lumen, 10 cases. In the presence of female urethritis classified as above, the most frequently observable bladder change was trabeculation (58%). In almost all cases of bladder trabeculation, there were always moderate or remarkable changes in the urethra and in the bladder neck. Mild congestions of the trigone were observed in one third of the cases and diffuse congestion or swelling in 19 cases. There were also cellule formation in 4 cases and hollow formation in 7 cases. The grade of the vesical changes, however, did not stand for the severity of the urethral changes. This is true also in urinary and non-urinary symptoms. In this study, urethritis classified as groups 3 and 4, especially the group 4, seems to stand far beyond ordinary conservative treatment. Trausurethral electrocoagulation or electroresction are favorable in these cases.

A Clinical Study of Tubercle Bacilli in Urine of the Patients with Pulmonary Tuberculosis / 대한비뇨기과학회지

One hundred and twenty-six patients with pulmonary tuberculosis having no clinical evidence of genito-urinary tuberculosis were studied for tubercle bacilli in their urine and the following results were obtained 0f 126 patients studied, 5 cases (4.0%) were found having positive tubercle bacilli in urine. of which three were found in the moderately advanced cases of pulmonary tuberculosis and two in the far-advanced. While, in the treated group of 56 with anti-tuberculous drugs for pulmonary tuberculosis, three cases were positive for tubercle bacilli in urine, of which two were found in the moderately advanced and one in the far-advanced of pulmonary tuberculosis, two cases were also positive in the non-treated group of 70, of which one was found in the moderately advanced and another in the far-advanced of pulmonary tuberculosis. Two instances of positive tubercle bacilli in urine were found in the group of treatment for less than 6 months and only one in patients having treatment for more than 6 months.

A Clinical Study of 123 Cases on the Urethral Anesthesia and Analgesia / 대한비뇨기과학회지

No abstract available.

Endoscopic Evaluation Ninty-one Cases of Chronic Prostatitis / 대한비뇨기과학회지

Ninety-one cases of chronic prostatitis were studied endoscopically and the results were evaluated. Endoscopic appearance of the bladder neck in the presence of chronic prostatitis was classified as 1. Normal bladder neck, 16 cases (17.5 per cent) 2. Elevated posterior urethra, 8 cases (8.7 per cent) 3. Contracture of the neck, 19 cases (20.8 per cent) 4. Diffuse, irregular swelling and narrowing of the neck, 19 cases (20.8 per cent) 5. Reversed V-neck, 2S cases (31.8 per cent) In this study it was found that the bladder neck was abnormal in 82.1 per cent of the cases. In 36 instances or 39.5 per cent. the verumontanum appeared normal but abnormal in 55 cases or 60.5 per cent. Bilateral prostatic urethral walls were inflammatory in 57 cases and unilaterally inflammatory in 6 cases. Forty-two cases (46.1 per cent) revealed elevation of the posterior urethra and the prostatic urethral floor was hyperemic and edematous in 44 cases. In 40 cases (43.9 per cent), the normal bladder mucosa was observed, trabeculation and cellulation in 43 cases and trigonal and interureteric thickening in 7 cases were also observed. Decreased libido was present in 12 instances (33.3 per cent) of 36 cases having normal verumontanum and in 25 instances (45.4 per cent) of 55 cases having abnormal one. Urinary symptoms were most frequently positive in cases with bladder neck contracture. The results of treatment using Ultzmann's urethral syringe were evaluated as follows: Complete cure was obtained in 8 cases (19.5 per cent) almost complete cure in 14 cases (34.1 per cent), improvement in 15 cases (36.5 per cent) and no remarkable change in 4 cases (9.7 per cent). Five cases had transurethral resection and four achieved almost complete cure and one improved clinically. Subjective symptoms were completely relieved in 23 cases (56.1 per dent) and more than two thirds of the previous symptoms were gone in 18 cases (43.9 per cent) after treatment. In summary. endoscopic examination on chronic prostatitis is s worthwhile and important procedure in establishing therapeutic criteria.